Injuries underbody blast fatalities: identification of five distinct mechanisms of head injury
File(s)
Accepted version
Author(s)
Ashworth, Emily
Baxter, D
Gibb, I
Wilson, Mark
Bull, anthony
Type
Journal Article
Abstract
Previous research has shown that injuries to the head and neck were prevalent in 73%
of all mounted fatalities of underbody blast. The mechanisms that cause such injuries to the
central nervous system are not yet known. The aim of this study was to identify the head and
spinal injuries in fatalities due to underbody blast and then develop hypotheses on the causative
mechanisms.
All UK military fatalities from underbody blast who suffered a head injury from 2007-
2013 in the Iraq and Afghanistan conflicts were identified retrospectively. Post-mortem CTs
(PMCTs) were interrogated for injuries to the head, neck and spine. All injuries were
documented and classified using a radiology classification. Chi-squared and Fisher’s Exact
tests were used to show a relationship between variables and form a hypothesis for injury
mechanisms.
There were 50 fatalities from underbody blast with an associated head injury. Of these,
46 had complete CTPMs available for analysis. Chi-squared and Fisher’s exact showed a
relationship between lateral ventricle blood and injuries to the abdomen and thorax.
Five partially overlapping injury constellations were identified:
1. multiple level spinal injury with skull fracture and brainstem injury;
2. perimesencephalic haemorrhage
3. spinal and brainstem injury;
4. parenchymal contusions with injury to C0-C1; and
5. an eggshell pattern of fractures from direct impact.
These injury constellations can now be used to propose injury mechanisms in order to
develop mitigation strategies or clinical treatments.
of all mounted fatalities of underbody blast. The mechanisms that cause such injuries to the
central nervous system are not yet known. The aim of this study was to identify the head and
spinal injuries in fatalities due to underbody blast and then develop hypotheses on the causative
mechanisms.
All UK military fatalities from underbody blast who suffered a head injury from 2007-
2013 in the Iraq and Afghanistan conflicts were identified retrospectively. Post-mortem CTs
(PMCTs) were interrogated for injuries to the head, neck and spine. All injuries were
documented and classified using a radiology classification. Chi-squared and Fisher’s Exact
tests were used to show a relationship between variables and form a hypothesis for injury
mechanisms.
There were 50 fatalities from underbody blast with an associated head injury. Of these,
46 had complete CTPMs available for analysis. Chi-squared and Fisher’s exact showed a
relationship between lateral ventricle blood and injuries to the abdomen and thorax.
Five partially overlapping injury constellations were identified:
1. multiple level spinal injury with skull fracture and brainstem injury;
2. perimesencephalic haemorrhage
3. spinal and brainstem injury;
4. parenchymal contusions with injury to C0-C1; and
5. an eggshell pattern of fractures from direct impact.
These injury constellations can now be used to propose injury mechanisms in order to
develop mitigation strategies or clinical treatments.
Date Issued
2022-12-30
Date Acceptance
2022-07-14
Citation
Journal of Neurotrauma, 2022, 40 (1-2), pp.1-7
ISSN
0897-7151
Publisher
Mary Ann Liebert
Start Page
1
End Page
7
Journal / Book Title
Journal of Neurotrauma
Volume
40
Issue
1-2
Copyright Statement
© 2023, Mary Ann Liebert, Inc., publishers. This is the accepted version of the following article: Injuries in Underbody Blast Fatalities: Identification of Five Distinct Mechanisms of Head Injury
Emily Ashworth, David Baxter, Iain Gibb, Mark Wilson, and Anthony M.J. Bull, which has now been formally published in final form at Journal of Neurotrauma at https://www.liebertpub.com/doi/abs/10.1089/neu.2021.0400. This original submission version of the article may be used for non-commercial purposes in accordance with the Mary Ann Liebert, Inc., publishers’ self-archiving terms and conditions.
Emily Ashworth, David Baxter, Iain Gibb, Mark Wilson, and Anthony M.J. Bull, which has now been formally published in final form at Journal of Neurotrauma at https://www.liebertpub.com/doi/abs/10.1089/neu.2021.0400. This original submission version of the article may be used for non-commercial purposes in accordance with the Mary Ann Liebert, Inc., publishers’ self-archiving terms and conditions.
Identifier
https://www.liebertpub.com/doi/10.1089/neu.2021.0400
Publication Status
Published
Date Publish Online
2022-12-30